title: Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study.
abstract: BACKGROUND
  The anterolateral thigh (ALT) flap has become increasingly popular due to its versatility and minimal donor site morbidity. Its major limitation has been uncertainty in predicting perforator anatomy, with the occasional absence of suitable perforators and high variability in their size and course. The variability of this anatomy has not been adequately explored previously.
  
  
  METHODS
  A cadaveric study was undertaken, in which 19 thighs (from 10 fresh cadavers) underwent contrast injection and angiographic imaging. Anatomical variations of the vasculature were recorded. A clinical study of 44 patients undergoing ALT flap reconstruction was also undertaken. Perforator anatomy was described in the first 32 patients, and the subsequent 12 patients underwent computed tomography angiography with a view to predicting individual anatomy and improving operative outcome.
  
  
  RESULTS
  Cadaver angiography was able to highlight and classify the variations in arterial anatomy, with four patterns observed and marked variability between cases. In 32 patients undergoing ALT flaps without preoperative CT angiography (CTA), five patients (16%) did not have any suitable perforators from the descending branch of the lateral circumflex femoral artery. By selecting the limb of choice with preoperative CTA, the incidence of flap unsuitability was reduced to 0%. Comparing CTA with Doppler, CTA was more accurate (sensitivity 100%) and provided more information.
  
  
  CONCLUSIONS
  The perforators supplying the ALT flap show significant variability in location and course, with the potential for unsuitable perforators limiting flap success. Preoperative CTA can demonstrate the vascular anatomy and can aid perforator selection and operative success.
authors.affiliation: Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Victoria, Australia. warrenrozen@hotmail.com
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ashton
authors.forename: Wei-Ren
authors.initials: WR
authors.lastname: Pan
authors.forename: Birgitte J
authors.initials: BJ
authors.lastname: Kiil
authors.forename: Vicki K
authors.initials: VK
authors.lastname: McClure
authors.forename: Damien
authors.initials: D
authors.lastname: Grinsell
authors.forename: Damien L
authors.initials: DL
authors.lastname: Stella
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Corlett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D001158:Arteries / Q000033:anatomy & histology* / Q000601:surgery; D002102:Cadaver; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D013848:Thigh / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed